Sex differences in the management of coronary artery disease

Richard M. Steingart, Milton Packer, Peggy Hamm, Mary Ellen Coglianese, Bernard Gersh, Edward M. Geltman, Josephine Sollano, Stanley Katz, Lem Moyé, Lofty L. Basta, Sandra J. Lewis, Stephen S. Gottlieb, Victoria Bernstein, Patricia Mcewan, Kirk Jacobson, Edward J. Brown, Marrick L. Kukin, Niki E. Kantrowitz, Marc A. Pfeffer

Research output: Contribution to journalArticle

705 Citations (Scopus)

Abstract

Background. Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial. Methods. We assessed the nature and severity of anginal symptoms and the use of antianginal and antiischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions ≤40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial. Results. Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P<0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P<0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization. Conclusions. Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.

Original languageEnglish (US)
Pages (from-to)226-230
Number of pages5
JournalNew England Journal of Medicine
Volume325
Issue number4
StatePublished - Jul 25 1991

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Sex Characteristics
Coronary Artery Disease
Cardiac Catheterization
Physicians
Stroke Volume
Infarction
Coronary Disease
Cause of Death
Myocardial Infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Steingart, R. M., Packer, M., Hamm, P., Coglianese, M. E., Gersh, B., Geltman, E. M., ... Pfeffer, M. A. (1991). Sex differences in the management of coronary artery disease. New England Journal of Medicine, 325(4), 226-230.

Sex differences in the management of coronary artery disease. / Steingart, Richard M.; Packer, Milton; Hamm, Peggy; Coglianese, Mary Ellen; Gersh, Bernard; Geltman, Edward M.; Sollano, Josephine; Katz, Stanley; Moyé, Lem; Basta, Lofty L.; Lewis, Sandra J.; Gottlieb, Stephen S.; Bernstein, Victoria; Mcewan, Patricia; Jacobson, Kirk; Brown, Edward J.; Kukin, Marrick L.; Kantrowitz, Niki E.; Pfeffer, Marc A.

In: New England Journal of Medicine, Vol. 325, No. 4, 25.07.1991, p. 226-230.

Research output: Contribution to journalArticle

Steingart, RM, Packer, M, Hamm, P, Coglianese, ME, Gersh, B, Geltman, EM, Sollano, J, Katz, S, Moyé, L, Basta, LL, Lewis, SJ, Gottlieb, SS, Bernstein, V, Mcewan, P, Jacobson, K, Brown, EJ, Kukin, ML, Kantrowitz, NE & Pfeffer, MA 1991, 'Sex differences in the management of coronary artery disease', New England Journal of Medicine, vol. 325, no. 4, pp. 226-230.
Steingart RM, Packer M, Hamm P, Coglianese ME, Gersh B, Geltman EM et al. Sex differences in the management of coronary artery disease. New England Journal of Medicine. 1991 Jul 25;325(4):226-230.
Steingart, Richard M. ; Packer, Milton ; Hamm, Peggy ; Coglianese, Mary Ellen ; Gersh, Bernard ; Geltman, Edward M. ; Sollano, Josephine ; Katz, Stanley ; Moyé, Lem ; Basta, Lofty L. ; Lewis, Sandra J. ; Gottlieb, Stephen S. ; Bernstein, Victoria ; Mcewan, Patricia ; Jacobson, Kirk ; Brown, Edward J. ; Kukin, Marrick L. ; Kantrowitz, Niki E. ; Pfeffer, Marc A. / Sex differences in the management of coronary artery disease. In: New England Journal of Medicine. 1991 ; Vol. 325, No. 4. pp. 226-230.
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AU - Hamm, Peggy

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AU - Geltman, Edward M.

AU - Sollano, Josephine

AU - Katz, Stanley

AU - Moyé, Lem

AU - Basta, Lofty L.

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AU - Gottlieb, Stephen S.

AU - Bernstein, Victoria

AU - Mcewan, Patricia

AU - Jacobson, Kirk

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N2 - Background. Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial. Methods. We assessed the nature and severity of anginal symptoms and the use of antianginal and antiischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions ≤40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial. Results. Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P<0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P<0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization. Conclusions. Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.

AB - Background. Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial. Methods. We assessed the nature and severity of anginal symptoms and the use of antianginal and antiischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions ≤40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial. Results. Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P<0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P<0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization. Conclusions. Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.

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